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Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: Key immunohistochemical profiles for differential diagnosis

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World Journal of Gastroenterology 2016年第38期22卷 8596-8604页

作者： Yusuke Ohara tatsuya Oda Shinji hashimoto Yoshimasa Akashi Ryoichi Miyamoto Tsuyoshi Enomoto Kaishi Satomi Yukio Morishita Nobuhiro Ohkohchi Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Faculty of MedicineUniversity of Tsukuba Department of Diagnostic Pathology Faculty of MedicineUniversity of Tsukuba Diagnostic Pathology Division Tokyo Medical University Ibaraki Medical Center

AIM To reveal better diagnostic markers for differentiating neuroendocrine tumor(NET) from solid-pseudopapillary neoplasm(SPN), focusing primarily on immunohistochemical analysis.METHODS We reviewed 30 pancreatic surgical specimens of NET(24 cases) and SPN(6 cases). We carried out comprehensive immunohistochemical profiling using 9 markers: Synaptophysin, chromogranin A, pancytokeratin, E-cadherin, progesterone receptor,vimentin, α-1-antitrypsin, CD10, and β-catenin.RESULTS E-cadherin staining in NETs, and nuclear labeling of β-catenin in SPNs were the most sensitive and specific markers. Dot-like staining of chromogranin A might indicate the possibility of SPNs rather than NETs. The other six markers were not useful because their expression overlapped widely between NETs and SPNs. Moreover, two cases that had been initially diagnosed as NETs on the basis of their morphological features, demonstrated SPN-like immunohistochemical profiles. Careful diagnosis is crucial as we actually found two confusing cases showing disagreement between the tumor morphology and immunohistochemical profiles.CONCLUSION E-cadherin, chromogranin A, and β-catenin were the most useful markers which should be employed for differentiating between NET and SPN.

关键词： Neuroendocrine tumor Pancreas Solidpseudopapillary neoplasm Immunohistochemistry Diagnosis

Neuroendocrine carcinoma of the extrahepatic bile duct: A case report

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World Journal of Gastroenterology 2016年第30期22卷 6960-6964页

作者： Yukio Oshiro Ryozo Gen Shinji hashimoto tatsuya Oda Taiki Sato Nobuhiro Ohkohchi Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Faculty of Medicine University of Tsukuba Department of Pathology Faculty of MedicineUniversity of Tsukuba

Neuroendocrine carcinoma(NEC) originating from the gastrointestinal hepatobiliary-pancreas is a rare, invasive, and progressive disease, for which the prognosis is extremely poor. The patient was a 72-year-old man referred with complaints of jaundice. He was diagnosed with middle extrahepatic cholangiocarcinoma(cT 4N1M0, c Stage Ⅳ). He underwent a right hepatectomy combined with extrahepatic bile duct and portal vein resection after percutaneous transhepatic portal vein embolization. Microscopic examination showed a large-cell neuroendocrine carcinoma according to the WHO criteria for the clinicopathologic classification of gastroenteropancreatic neuroendocrine tumors. Currently, the patient is receiving combination chemotherapy with cisplatin and etoposide for postoperative multiple liver metastases. Although NEC is difficult to diagnose preoperatively, it should be considered an uncommon alternative diagnosis.

关键词： Neuroendocrine carcinoma Extrahepatic bile duct Neuroendocrine tumor

大鼠静脉持续输注瑞芬太尼可诱发输注时长相关性一过性痛觉过敏

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麻醉与镇痛 2013年第2期9卷 10-16页

作者： Ryosuke Ishida Tetsuro Nikai Tatsuya Hashimoto Toshiko Tsumori Yoji Saito 李卉(译) 王焱林(校) Departments of Shimane University Faculty of Medicine Shimane Japan Departments of matomy and Morphological Neuroscience Shimane University Faculty of Medicine Shimane Japan 不详

背景最近研究表明，瑞芬太尼和其他仙型阿片受体激动剂一样可能会引起痛觉过敏。因此，我们拟通过动物实验（采用临床实践中应用的管理模型）研究静脉给予瑞芬太尼，观察瑞芬太尼是否可以日l起痛觉过敏以其Bj起痛觉过敏的条件。此外，... 详细信息

背景最近研究表明，瑞芬太尼和其他仙型阿片受体激动剂一样可能会引起痛觉过敏。因此，我们拟通过动物实验（采用临床实践中应用的管理模型）研究静脉给予瑞芬太尼，观察瑞芬太尼是否可以日l起痛觉过敏以其Bj起痛觉过敏的条件。此外，我们还研究输注瑞芬太尼引起的痛觉过敏是否与细胞外信号调节蛋白ERK1／2激酶磷酸化有关。方法雄性SD大鼠，经尾静脉置管，持续给予瑞芬太尼（30μg·kg^-1·min^-1）10分钟，或持续给予瑞芬太尼（0．1／1／10μg·kg^-1·min^-1）30分钟，或给予瑞芬太尼（0．1／1／3／10μg·kg^-1·min^-1）120分钟。随后行vonFrey测试及甩尾实验，并用免疫组化法测ERK1／2蛋白表达。在此基础上，观察鞘内预先给予MAPK抑制剂U0126是否可抑制瑞芬太尼引起痛觉过敏。结果瑞芬太尼的镇痛作用呈剂量依赖性，作用时间短恢复迅速。10分钟或30分钟的输注不会引起痛觉过敏。然而，各种剂量的瑞芬太尼120分钟组与对照组相比，甩尾潜伏期和终止输液后机械痛阈值均降低。但痛觉过敏持续时间不超过60分钟。与瑞芬太尼30分钟组（无痛觉过敏）相比，瑞芬太尼120分钟组（有痛觉过敏）脊髓背侧角神经元ERK1／2磷酸化明显增加，但U0126并不能抑制输注瑞芬太尼所导致的痛觉过敏。结论静脉输注瑞芬太尼可以引起短暂的药物撤退性痛觉过敏。这种痛觉过敏与瑞芬太尼持续输注的时间有关。与我们的假设相反，ERK1／2并不是51起痛觉过敏的一个必要因素。

关键词：静脉持续输注瑞芬太尼痛觉过敏 SD大鼠 ERK1 2 一过性相关性阿片受体激动剂

Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma

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World Journal of Gastroenterology 2014年第32期20卷 11451-11455页

作者： Ryoichi Miyamoto Yukio Oshiro Shinji hashimoto Keisuke Kohno Kiyoshi Fukunaga tatsuya Oda Nobuhiro Ohkohchi Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation Department of Surgery University of Tsukuba Ibaraki 305-8575 Japan

The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional(3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In thisreport, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.

关键词： 3-dimensional imaging Hepatobiliary and pancreatic

X-ray diagnosis with a bloating agent for foreign object ingestion

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World Journal of Clinical Cases 2014年第5期2卷 157-159页

作者： Hirokazu Tomishige Zenichi Morise tatsuya Suzuki Fujio Hara Masahito Hibi Takazumi Kato Takashi hashimoto Department of Surgery Fujita Health University School of MedicineBanbuntane Houtokukai HospitalNagoyaAichi 454-8509Japan Department of Pediatric Surgery Fujita Health University School of MedicineToyoakeAichi 470-1192Japan

The location of an ingested foreign object is often difficult to determine by X-ray if gastric air bubbles are not clear in the image.Methods that provide negative contrast can facilitate precise object localization,which is important for object retrieval and treatment of the patient.This case report describes a male child,2 years and 2 mo of age,who accidentally swallowed a lithium battery while playing at home.A plain X-ray showed that the battery was in the abdomen,but it was unclear whether the object was still inside the stomach.A second X-ray examination performed after oral administration of a bloating agent to produce expansion of the stomach and provide negative contrast confirmed that the ingested battery was still in the stomach.The battery was then carefully removed using magnetic and balloon catheters under fluoroscopic guidance.This case report describes the successful use of an orally administered bloating agent without pain to the child in orderto determine the precise location of a foreign object in the abdomen.

关键词： Accidental ingestion Bloating agent X-ray Minimal invasion Foreign object

Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy

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World Journal of Gastroenterology 2024年第14期30卷 2006-2017页

作者： Kazuhiro Takahashi Masahiko Gosho Yoshihiro Miyazaki Hiromitsu Nakahashi Osamu Shimomura Kinji Furuya Manami Doi Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Tsuyoshi Enomoto Shinji hashimoto tatsuya Oda Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery University of TsukubaTsukuba 3058-575IbarakiJapan Department of Biostatistics University of TsukubaTsukuba 3058-575IbarakiJapan

BACKGROUND The success of liver resection relies on the ability of the remnant liver to regenerate.Most of the knowledge regarding the pathophysiological basis of liver regeneration comes from rodent studies,and data on humans are scarce.Additionally,there is limited knowledge about the preoperative factors that influence postoperative regeneration.AIM To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver regenera-tion.METHODS A total of 268 patients who received partial hepatectomy were enrolled.Patients were grouped into right hepatectomy/trisegmentectomy(RH/Tri),left hepa-tectomy(LH),segmentectomy(Seg),and subsegmentectomy/nonanatomical hepatectomy(Sub/Non)groups.The regeneration index(RI)and late rege-neration rate were defined as(postoperative liver volume)/[total functional liver volume(TFLV)]×100 and(RI at 6-months-RI at 3-months)/RI at 6-months,respectively.The lower 25th percentile of RI and the higher 25th percentile of late regeneration rate in each group were defined as“low regeneration”and“delayed regeneration”.“Restoration to the original size”was defined as regeneration of the liver volume by more than 90%of the TFLV at 12 months postsurgery.RESULTS The numbers of patients in the RH/Tri,LH,Seg,and Sub/Non groups were 41,53,99 and 75,respectively.The RI plateaued at 3 months in the LH,Seg,and Sub/Non groups,whereas the RI increased until 12 months in the RH/Tri group.According to our multivariate analysis,the preoperative albumin-bilirubin(ALBI)score was an independent factor for low regeneration at 3 months[odds ratio(OR)95%CI=2.80(1.17-6.69),P=0.02;per 1.0 up]and 12 months[OR=2.27(1.01-5.09),P=0.04;per 1.0 up].Multivariate analysis revealed that only liver resection percentage[OR=1.03(1.00-1.05),P=0.04]was associated with delayed regeneration.Furthermore,multivariate analysis demonstrated that the preoperative ALBI score[OR=2.63(1.00-1.05),P=0.02;per 1.0 up]and liver resection percentage[OR=1.02(1.00

关键词： Liver regeneration Albumin-bilirubin score Liver resection percentage Partial hepatectomy Human Regeneration index

Conversion hepatectomy for hepatocellular carcinoma with main portal vein tumour thrombus after lenvatinib treatment: A case report

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World Journal of Hepatology 2021年第3期13卷 384-392页

作者： Kazuhiro Takahashi Jaejeong Kim Amane Takahashi Shinji hashimoto Manami Doi Kinji Furuya Ryosuke hashimoto Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Katsuji Hisakura Tsuyoshi Enomoto Osamu Shimomura Masayuki Noguchi tatsuya Oda Department of Gastrointestinal and Hepatobiliary Pancreatic Surgery University of TsukubaTsukuba 3058575IbarakiJapan Department of Gastroenterological Surgery Saitama Cancer CenterSaitama 3620806SaitamaJapan Department of Diagnostic Pathology University of TsukubaTsukuba 3058575IbarakiJapan

BACKGROUND Hepatocellular carcinoma(HCC)accompanied by portal vein tumour thrombus(PVTT)presents an aggressive disease course,worsening liver function reserve,and a high recurrence rate.Clinical practice guidelines recommend systemic therapy as the first-line option for HCC with portal invasion.However,to achieve longer survival in these patients,the treatment strategy should be concluded with removal of the tumour by locoregional therapy.We experienced a case of initially unresectable HCC with main PVTT converted to radical hepatectomy after lenvatinib treatment.CASE SUMMARY A 59-year-old male with chronic hepatitis C infection visited our clinic as a regular post-surgery follow-up.Contrast-enhanced abdominal computed tomography revealed a liver mass diffusely located at the lateral segment with a massive PVTT extending from the umbilical portion to the main and contralateral third-order portal branches.With the diagnosis of unresectable HCC with Vp4(main trunk/contralateral branch)PVTT,lenvatinib was started at 12 mg/d.The computed tomography taken 3 mo after starting lenvatinib showed regression of the PVTT,which had retreated to the contralateral first-order portal branch.He tolerated the full dose without major adverse effects.With cessation of lenvatinib for 7 d,radical left lobectomy and PVTT thrombectomy were conducted.The patient’s postoperative course was uneventful.Microscopically,the primary lesion showed fibrotic changes,with moderately to poorly differentiated tumour cells surrounded by granulation tissues in some areas.The majority of the PVTT showed necrosis.He was alive without recurrence for 8 mo.CONCLUSION This is the first case of HCC with Vp4 PVTT in which radical conversion hepatectomy was succeeded after lenvatinib treatment.

关键词： Hepatocellular carcinoma Lenvatinib Portal vein tumour thrombus Conversion hepatectomy Case report

Risk factors for de novo hepatitis B during solid cancer treatment

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World Journal of Clinical Cases 2020年第24期8卷 6264-6273页

作者： Rie Sugimoto Masayuki Furukawa Takeshi Senju Yoshihusa Aratake Yuki Tanaka Hiroki Inada tatsuya Noguchi Lingaku Lee Masami Miki Yuji Maruyama Risa hashimoto Terumasa Hisano Mototsugu Shimokawa Department of Hepato-Biliary-Pancreatology National Hospital Organization Kyushu Cancer CenterFukuoka City 811-1395Fukuoka PrefectureJapan National Hospital Organization Kyushu Cancer Center Clinical Research InstituteFukuoka City 811-1395Fukuoka PrefectureJapan Department of Biostatistics Yamaguchi University Graduate School of MedicineUbe City 755-8505Yamaguchi PrefectureJapan

BACKGROUND Reactivation of hepatitis B virus(HBV)during anticancer treatment is a critical issue.When treating patients with solid tumors,it is unclear whether specific cancer types or treatments affect HBV reactivation in hepatitis B surface antigen(HBsAg)-negative and hepatitis B core antibody(HBcAb)-positive patients,socalled de novo hepatitis B patients.The risk of de novo hepatitis B may vary based on different background factors.AIM To determine the frequency and risk factors for de novo hepatitis B during solid tumor treatment.METHODS This retrospective cohort study comprised 1040 patients without HBsAgs and with HBcAbs and/or hepatitis B surface antibodies(HBsAbs).The patients were treated for solid cancer from 2008 to 2018 at the National Kyushu Cancer Center and underwent HBV DNA measurements.Patient characteristics and disease and treatment information were investigated.HBV DNA measurements were performed using TaqMan polymerase chain reaction(PCR).To identify the risk factors associated with HBV DNA expression,the age,sex,original disease,pathology,treatment method,presence or absence of hepatitis C virus(HCV),and HBsAb and/or HBcAb titers of all subjects were investigated.In patients with HBV DNA,the time of appearance,presence of HBsAgs and HBsAbs at the time of appearance,and course of the subsequent fluctuations in virus levels were also investigated.RESULTS Among the 1040 patients,938 were HBcAb positive,and 102 were HBcAb negative and HBsAb positive.HBV DNA expression was observed before the onset of treatment in nine patients(0.9%)and after treatment in 35 patients(3.7%),all of whom were HBcAb positive.The HBV reactivation group showed significantly higher median HBcAb values[9.00(8.12-9.89)vs 7.22(7.02-7.43),P=0.0001]and significantly lower HBsAb values(14 vs 46,P=0.0342)than the group without reactivation.Notably,the reactivated group showed a significantly higher proportion of cancers in organs related to digestion and absorption(79.0%vs 58.7%,P=0.0051).A high HBcAb titer and cancers in orga

关键词： Hepatitis B Reactivation Solid cancer treatment Digestion and absorption organ Hepatitis B surface antibody Hepatitis B core antibody titer

静脉泵注瑞芬太尼对福尔马林致痛大鼠脊髓敏感化的影响

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中国疼痛医学杂志 2010年第5期16卷 280-284页

作者：邓立琴二階哲朗齐藤洋司桥本龍也滕部由贵子孟尽海宁夏医科大学附属医院麻醉科银川750004 日本岛根大学医学部麻醉科出云693-8501

目的：观察短期静脉泵注不同剂量瑞芬太尼后对福尔马林致痛大鼠行为学和脊髓后角c-Fos蛋白表达的影响。方法：选择体重250~300g,右侧颈内静脉置管后恢复良好的雄性SD大鼠18只,随机分为3组（n=6）：对照组（C组）、低剂量瑞芬太尼组（LR... 详细信息

目的：观察短期静脉泵注不同剂量瑞芬太尼后对福尔马林致痛大鼠行为学和脊髓后角c-Fos蛋白表达的影响。方法：选择体重250~300g,右侧颈内静脉置管后恢复良好的雄性SD大鼠18只,随机分为3组（n=6）：对照组（C组）、低剂量瑞芬太尼组（LR组）和高剂量瑞芬太尼组（HR组）。三组大鼠均在右侧跖底皮下注射5%福尔马林50μl,注射前5min LR组和HR组分别经右侧颈内静脉持续泵注瑞芬太尼5μg/kg/min、30μg/kg/min,对照组（C组）泵注生理盐水至注射后5min停止泵注。记录福尔马林注射后第一阶段（0~5min）和第二阶段（15~90min）内累计舔爪时间和注射后2h,L4~5脊髓后角Ⅰ-Ⅱ、Ⅲ-Ⅳ、Ⅴ-Ⅵ板层c-Fos蛋白表达阳性的神经细胞数量。结果：持续静脉泵注瑞芬太尼5μg/kg/min和30μg/kg/min均可完全抑制第一阶段疼痛行为,推迟第二阶段的疼痛行为开始和中止,HR组尤为显著（P〈0.01）,但第二阶段总的累计舔爪时间三组差异无统计学意义。三组脊髓c-Fos蛋白表达阳性的神经细胞数量差异也无统计学意义。结论：短期应用瑞芬太尼不加重福尔马林致痛大鼠的痛觉过敏。

关键词：瑞芬太尼福尔马林痛觉过敏 c-Fos